Impacto de la prescripción temprana de inhibidores de SGLT2 en los resultados de la insuficiencia cardiaca aguda descompensada: evidencia del mundo real

IF 5.9 2区 医学 Q2 Medicine
Luis E. Echeverría , Lyda Z. Rojas , Angie Yarlady Serrano-García , Daniel R. Botero , María Cantillo-Reines , Adriana M. Jurado , Karen Andrea García-Rueda , Ángela Torres-Bustamante , Diana Ivonne Cañón-Gómez , Carolina Idrovo-Turbay , Robinson Sánchez-García , Jaime Alberto Rodríguez , Sergio A. Gómez-Ochoa
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Abstract

Introduction and objectives

Although sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown benefits in acute decompensated heart failure (ADHF), the extrapolability of clinical trial results to general populations remains limited. This study evaluated the impact of early in-hospital SGLT2i prescription on ADHF outcomes in a real-world setting.

Methods

Prospective cohort study. Adults with ADHF from a third-level cardiovascular center were included. The primary analysis compared early SGLT2i (prescribed within 48 hours of admission) versus late SGLT2i (prescribed after 48 hours). A secondary analysis included patients not receiving in-hospital SGLT2i. The primary outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay, 30-day improvement in the Minnesota Living with Heart Failure Questionnaire score, 30-day rehospitalization due to heart failure, and 30-day all-cause mortality.

Results

Of 2016 patients, early SGLT2i (≤ 48 h) was initiated in 1275 (63.2%) patients, late SGLT2i in 346 (17.2%), and 395 (19.6%) did not receive in-hospital SGLT2i. After multivariate adjustment, early versus late SGLT2i use was associated with decreased in-hospital mortality (RR, 0.37; 95%CI, 0.17-0.77) and reduced hospital stay (mean difference −5.70 days; 95%CI, −7.05 to −4.34). Similarly, early versus late or no in-hospital SGLT2i use was associated with decreased in-hospital mortality (RR, 0.25; 95%CI, 0.14-0.44), reduced hospital stay (mean difference −2.99 days; 95%CI, −4.05 to −1.92), and lower 30-day combined mortality/heart failure rehospitalization (RR, 0.72; 95%CI, 0.53-0.98).

Conclusions

Early in-hospital SGLT2i prescription was associated with improved cardiovascular outcomes in ADHF in a real-world setting.
早期开SGLT2抑制剂对急性缺损性心力衰竭结果的影响:真实世界的证据
虽然钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)已显示出对急性失代偿性心力衰竭(ADHF)的益处,但临床试验结果对一般人群的可推广性仍然有限。本研究评估了在现实世界中早期住院SGLT2i处方对ADHF结果的影响。方法前瞻性队列研究。纳入了来自三级心血管中心的ADHF成人患者。初步分析比较了早期SGLT2i(入院48小时内开药)和晚期SGLT2i(48小时后开药)。二次分析纳入了未在医院接受SGLT2i治疗的患者。主要终点是住院死亡率。次要结局包括住院时间、明尼苏达州心力衰竭患者问卷评分30天改善、心力衰竭30天再住院以及30天全因死亡率。结果2016年患者中,早期SGLT2i(≤48 h)患者1275例(63.2%),晚期SGLT2i患者346例(17.2%),395例(19.6%)未接受住院SGLT2i治疗。多因素调整后,早期与晚期使用SGLT2i与住院死亡率降低(RR, 0.37; 95%CI, 0.17-0.77)和住院时间缩短(平均差为- 5.70天;95%CI, - 7.05 - - 4.34)相关。同样,早期与晚期或不住院使用SGLT2i与住院死亡率降低(RR, 0.25; 95%CI, 0.14-0.44)、住院时间缩短(平均差为- 2.99天;95%CI, - 4.05至- 1.92)以及30天合并死亡率/心力衰竭再住院率降低(RR, 0.72; 95%CI, 0.53-0.98)相关。结论:在现实世界中,早期住院SGLT2i处方与ADHF患者心血管结局的改善相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Revista espanola de cardiologia
Revista espanola de cardiologia 医学-心血管系统
CiteScore
4.20
自引率
13.60%
发文量
257
审稿时长
28 days
期刊介绍: Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.
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